Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2019
Complete relief of CRPS-associated pain during magnesium infusion in a patient with postpartum preeclampsia.
A pregnant patient with chronic regional pain syndrome (CRPS) and indwelling spinal cord stimulator presented with twin gestation for induction of preterm labor due to preeclampsia. Intravenous magnesium was initiated and a lumbar epidural catheter was placed uneventfully for labor analgesia. The patient reported complete relief of her CRPS-associated pain during and for 24 hours after delivery, while receiving intravenous magnesium, with her pain symptoms returning shortly after discontinuing magnesium. To our knowledge, there are no case reports that describe CRPS-associated pain relief while on peripartum magnesium therapy.
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Reg Anesth Pain Med · Jan 2019
Comparative StudySpread of dye injectate in the distal femoral triangle versus the distal adductor canal: a cadaveric study.
The nerve to vastus medialis (NVM) supplies sensation to important structures relevant to total knee arthroplasty via a medial parapatellar approach. There are opposing findings in the literature about the presence of the NVM within the adductor canal (AC). The objective of this cadaveric study is to compare the effect of injection site (distal femoral triangle (FT) vs distal AC) on injectate spread to the saphenous nerve (SN) and the NVM. ⋯ Our findings suggest that an injection in the distal AC may be suboptimal for knee analgesia as it may spare the NVM, while an injection in the distal FT could provide greater analgesia to the knee but may result in undesirable motor blockade from spread to the nerve to vastus intermedius.
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Reg Anesth Pain Med · Jan 2019
Randomized Controlled TrialInfluence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial.
To investigate the possible effect of postoperatively applied analgesics-epidurally applied levobupivacaine or intravenously applied morphine-on systemic inflammatory response and plasma concentration of interleukin (IL)-6 and to determine whether the intensity of inflammatory response is related to postoperative cognitive dysfunction (POCD). ⋯ There is a statistically significant association between use of epidural levobupivacaine and a reduction in some inflammatory markers. Postoperative patient-controlled epidural analgesia reduces the incidence of POCD compared with intravenous morphine analgesia in the studied population.